There are no specific X-ray findings associated with amenorrhea. There are no X-ray findings associated with most common causes of amenorrhea, like polycystic ovary syndrome (PCOS) and premature ovarian failure. However, an X-ray may be helpful in the diagnosis of delayed puberty.

• There are no X-ray findings associated with amenorrhea exclusively.
• There are no X-ray findings associated with most common causes of amenorrhea, like polycystic ovary syndrome (PCOS) and premature ovarian failure.
• However, an X-ray may be helpful in the diagnosis of delayed puberty.
  • A strong association is found between bone age and the onset of puberty in boys with developmental disorders.^[2][3]
  • Skeletal maturation and hypothalamus–pituitary–gonadal axis maturation rates are related to each other. Delayed puberty is related to the skeletal maturation delay, that can be caused by various conditions include:
    • Chronic diseases^[4]
    • Malnutrition^[5]
    • Hypothyroidism^[6]
    • Constitutional delay of growth^[7]
    • Growth hormone (GH) deficiency^[8]
  • For measuring bone age by means of X-ray, the left hand and wrist should be used. Greulich and Pyle Atlas may be used to interpret the findings.^[9][10]
  • If the difference between measured bone age and chronological age is more than 2 years, it is diagnostic of constitutional delay of growth and puberty (CDGP).
  • The metaphysis of the patients with delayed puberty usually takes longer duration to mature when compared to the normal population. Thus, final adult height in patients of delayed puberty is slightly more than the final adult height of a normal individual. If the bone age shows a difference of ≥ 4 years, it may reflect an additional increase of 8 cm in the final adult height of the patient with delayed puberty. Final adult height can be calculated through Bayley-Pinneau tables.^[11][12]